YOUR INFORMATON   Name * Address City State - - Choose One - - Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code Home Phone * Cell Phone E-Mail Address * How did you hear about MTC MainStage? *     2010/11 ANNUAL MEMBERSHIP   Select Membership Level * Make Selection $100 / Actor $250 / Designer $500 / Director $1000 / Producer $2500 / Executive Producer How would you like to pay for your membership? * Select Option: I would like to pay my entire membership in one payment. I would like to pay my membership over ten monthly payments. I will send my company’s Matching Gift form. Select: Yes No Gifts of $100 and over are recognized in the MTC MainStage 2010/11 Season program. I would like my name to appear as follows:     PAYMENT INFORMATION   GRAND TOTAL (total paying today) = *